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A 68-year-old male presented to his primary care physician for evaluation of worsening headaches. He reported a 3-month history of daily, progressively worsening right-sided retro-orbital headaches that were becoming increasingly intolerable.

Headaches were associated with nausea, photophobia, and increasingly blurry vision. Blurry vision was most noticeable in the right temporal visual field and caused him to have difficulty with depth perception.

He also described a 16-month history of low libido, loss of axillary and chest hair, decreased testicular volume, and gynecomastia, for which he has been receiving testosterone injections. His low libido was worsening and accompanied by symptoms of alternating hot and cold intolerance, tremulousness, and unintentional weight loss. He also described alternating hot and cold intolerance, tremulousness, and unintentional weight loss.


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  1. FIRAS Alkhalaf

    From the history ,the picture directed us to pituitary pathology
    We might ask for
    ophthalmological consultantion
    Hormonal study workup

    1. Iram Shafqat, Author

      I agree with all of the above! Prior to an ophthalmological consultation, would you do an eye exam yourself? Perhaps you could avoid the consult if you can explain the symptoms with the other tests you mentioned.

  2. Dr. Waleed Basha

    Needs to do CT scan and MRI nose, para-nasal sinuses, and brain +/- contrast .
    Q. Pituitary gland tumor.

    1. Iram Shafqat, Author

      Yes, the pituitary gland is an important structure localized by his symptoms. Would you choose to get an MRI pituitary after the preliminary imaging you suggested? Thank you for participating!

  3. Christine

    Are there any nasal or sinus type symptoms? Sounds like a pituitary gland might be having problems. Time to get a CT or MRI scan.

    1. Iram Shafqat, Author

      There were no symptoms of rhinorrhea, congestion, or other sinus symptoms. You are right, though, pituitary imaging will be necessary!


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